Internal Medicine Exams Dr. Lama El Banna Al Azhar University Gaza Palestine

1. 4. a protein hormone
32. b
34. d
37. c
39. c
41. c
65. c
Choose the most correct answer:
1. Diabetes mellitus may be caused by
o Endocrine disease such as Cushing’s syndrome or Acromegaly
o Bacterial infection
o Muscular dystrophy
o Eating too much sugar
2. Oral glucose tolerance test(OGTT)
o A 75 gm glucose load is usually used
o Can be very dangerous and must be avoided in the elderly
o If fasting blood glucose is 100 mg/dl, OGGT is needed t establish the
o diagnosis of diabetes
o OGGT can differentiate between Type 1 and Type 2 diabetes
3. High plasma insulin levels has the following effects
o It stimulates breakdown of adipose tissue
o It stimulates the storage of glycogen in the liver
o It enhances protein catabolism
o It increases the absorption of glucose from the intestine
4. Insulin is
o A carbohydrate
o A protein hormone
o An enzyme
o A catalyst
5. Gestational diabetes
o Occurs when a pregnant eats too much
o Occurs when a diabetic becomes pregnant
o Occurs when a pregnant woman becomes diabetic
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2. o Occurs when the fetus becomes diabetic
6. When there is severe lack of insulin, blood glucose increases and
o Polyuria and dehydration develops
o Edema develops
o Tachycardia develops
o Exophthalmus develops
7. People with Type 2 diabetes
o Are ketosis prone
o Are mostly young
o Are definitely obese
o Have a gradual onset of the disease
8. People with Type 1 diabetes
o Are old and mostly over 30 years
o Type 1 diabetes can be due to autoimmune disease causing damage to
the beta cells
o The disease may be caused by helminthic infestation
o The disease develops gradually in its clinical onset
9. In diabetes mellitus
o People with Type 2 diabetes do easily develop ketoacidosis
o Type 2 diabetes is a mild disease
o People with Type 2 diabetes are usually less than 30 year old
o Obesity is a risk factor
10. Insulin secretion is at its maximum in a normal individual
o During sleep
o Just after a meal
o Several hours after a meal
o During fasting
11. If a doctor suspect diabetes, he will usually test ..
o Urine for the presence of insulin
o Urine for the presence of acetone
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3. o Blood for the presence of insulin
o Blood for the presence of increased glucose levels
12. Which of the following findings in a glucose tolerance test confirm
the diagnosis of diabetes?
o A plasma glucose level in the 2 hours postprandial sample
above 200mg/dl and fasting at 140 mg/dl
o A plasma glucose level throughout the test of more than 120mg/dl
o A blood glucose level in the 2 hours posprandial sample at 150 mg/dl and
fasting at 110 mg/dl
13. Honeymoon period …
o Affects only people with Type 2 diabetes who are less than 30
years old
o Is only meant for newly married people with Type 1 diabetes
o Is another name for remission in Type 1diabetes where the pancreas
permanently has regained its ability to produce insulin
o Usually happens 2-4 months after a person with Type 1 diabetes has been
diagnosed and insulin therapy initiated
14. The most important function of insulin is …
o To release glucose from the liver
o To maintain normal blood glucose level
o To avoid late diabetic complications
o To utilize fat
15. In Type 1 diabetes
o Insulin is unable to promote utilization of glucose
o Pancreas does not produce insulin
o The cells of the body lack insulin receptors
o Blood glucose level may be normal
16. Persistent hyperglycemia may…
o Cause thirst, polyuria and tiredness
o Be asymptomatic for many years
o Cause enlargement of liver
o Cause late complication such as sarcoidosis
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4. 17. Why glucosuria is a consequence of hyperglycemia
o Because the kidneys are damaged
o Because the amount of blood filtered by the kidneys is incorrect
o Because the amount of blood filtered by the kidneys is decreased
o Because the kidneys are unable to reabsorb all the glucose in the
filtered blood
18. Hyperglycemia in diabetes mellitus occurs when there is lack of
insulin. It develops because…
o Glycogen is broken down to glucose in the liver.
o Glucose is not taken up by the brain.
o Glucose is taken up by muscle tissue.
o Protein is not broken down gluconeogenesis
19. Metformin …
o is an example of a sulphonylurea.
o Does not stimulate insulin secretion.
o Causes weight gain.
20. Hyperosmolar hyperglycemaemai ( HHS)…
o is not as dangerous as ketoacidosis.
o Is never seen in elderly people with Type 2 diabetes .
o Will cause much worse dehydration than DKA.
o Will not require hospitalization.
21. What treatment modes should be used in type 2 diabetes in order of
importance?
o Education, diet, exercice, OA’s, insulin.
o OA’s, exercise, diet, insulin, education.
o Exercise, diet, OA’s.
o Education, insulin, OA’s, exercise, diet.
22. Obesity:
o Obesity will improve insulin resistance.
o Obesity is best measured by the Body Mass Index (BMI).
o BMI over 20 is taken as indicator of obesity.
23. Chronic complications in diabetes…
o Tend to decrease with age.
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5. o Can be reduced or delayed by good metabolic control.
o Are reversible in the late stages.
24. The WHO recommendations for daily calorie intake are:
o 30% fat, 20% protein, 50% carbohydrate.
o More than 20% saturated fat.
o Less than 12 g of salt a day.
25. Intensified insulin therapy…
o Means injecting insulin minimum 3 times a day.
o Does not improve glycemic control.
o Is the same as conventional therapy.
26. The classical endocrine action
o Hormone may be secreted by a neighboring cell.
o Hormone may be secreted by the same cell.
o Hormone carried via blood from a secreting gland.
o Hormone may be manufactured in situ.
27. Hormone membrane receptors respond to the following hormone
o Steroid.
o Catecholamine.
o Thyroid hormones.
o Insulin.
28. Homeostasis means
o Arrest of bleeding.
o Keeping external environment stable.
o Maintaining stable internal environment of the body.
o Maximizing reaction towards internal environment.
29. Hormones are
o Chemical messengers which are secreted by glands via ducts.
o Secreted by the exocrine glands.
o Non-specialized chemical messenger.
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6. o Chemical messenger produced by specialized cells of the endocrine
system.
30. Hyperprolactinemia in females causes
o Galactorrhea amenorrhea syndrome.
o Obesity.
o Hypertension.
o Hyperglycemia.
31. Excess growth hormone secretion leads to
o Gigantism if it occurs after puberty.
o Acromegaly if it occurs before puberty.
o Gigantism if it occurs before puberty.
o Diabetes insipidus if it occurs after puberty.
32. The hormone vasopressin (AVP)
o Is synthesized in the posterior pituitary.
o Its secretion is defective in diabetes insipidus.
o Is important for lactation.
o Is released by a trophic hormone from hypothalamus.
33. The anterior lobe of the pituitary secrets
o Thyroid stimulating hormone (TSH).
o Anti diuretic hormone (ADH).
o Corticotrophin releasing hormone (CRH).
o Thyroid releasing hormone (TRH).
34. The level of total thyroxin (T4)
o Will be increased during pregnancy.
o Is usually normal in thyrotoxicosis.
o Is usually elevated in hypothyroidism.
o May be increased due to TBG deficiency.
35. In Graves' disease
o TSH is usually elevated.
o T4 elevated and T3 is low.
o Both FT4 and FT3 are elevated.
o ACTH is elevated.
36. Congenital adrenal hyperplasia
o Is due to ACTH deficiency.
o Is due to pituitary adenoma.
o Usually caused by 21-hydroxylase deficiency.
o Estrogen is produced in excess.
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7. (37) Which of the following is known as the master gland?
o Thyroid gland.
o Adrenal gland.
o Anterior pituitary gland.
o Ovary.
(38) The hypertension associated with phaeochromocytoma results
from:
o Increased release of glucocorticoids.
o Increased release of catecholamines.
o Increased secretion of adrenocorticotrophic hormone (ACTH).
o Increased secretion of aldosterone.
(39) Dysfunction of the posterior pituitary gland may cause which of
the following disorders:
o Gigantism.
o Graves' disease.
o Diabetes insipidus.
o Dwarfism.
(40) All of the following statements about corticosteroids are true
except:
o They are beneficial in inhibiting rejection of orgasm transplant.
o They are beneficial in combating inflammation.
o They are associated with changes in physical appeasers.
o They can be discontinued immediately when no longer needed.
(41) Hypophysectomy or destruction of the anterior pituitary seriously
affects the endocrine production of the following glands except the:
o Adrenal cortex.
o Thyroid.
o Pancreas.
o Testes.
o Ovaries.
(42) The thyroid gland produces these hormones: thyroxine (T4), tri-
iodothyronine
(T3), and calcitonin; the first two hormones are important for:
o Sexual development.
o Intellectual maturation.
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8. o Bone formation.
o Fertility.
(43) The element most essential for the biosynthesis of thyroid
hormones is:
o Sodium.
o Phosphorus.
o Calcium.
o Iodine.
(44) Graves' disease (diffuse toxic goitre) can cause a broad range of
symptoms that includes all the following except:
o Muscle weakness.
o Exophthalmus.
o Tremors.
o Cold intolerance.
(45) Myxedema is associated with following:
o Hypopituitarism.
o Hypoparthyroidism.
o Hyperthyroidism.
o Hypothyroidism.
(46) The symptoms of Addison's diseases result from dysfunction of
the:
o Adrenal cortex.
o Adrenal medulla.
o Pancreas.
o Hypothalamus.
o Posterior pituitary.
(47) Long term corticosteroid therapy is associated with development
of the following complications except:
o Diabetes mellitus.
o Osteoporosis.
o Psychosis.
o Goitre.
(48) The beta cells of pancreatic islets secret:
o Insulin.
o Glucagon.
o Epinephrine.
o Amylase.
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9. (49) The rate of insulin secretion is regulated chiefly by the:
o Amount of food ingested.
o Degree of physical activity.
o Blood glucose level.
o Endocrine response to emotional stress.
(50) When insulin production is inadequate, supplementary insulin
must be given parenterally rather than orally because the
hormone:
o Irritates gastrointestinal mucosa.
o Is inactivated by proteolytic enzymes.
o Has an emetic action.
o Destroying normal intestinal flora.
(51) The basic cause of diabetes mellitus is:
o A high sugar diet.
o Food intolerance.
o Insulin excess.
o Insulin deficiency.
(52) Diabetes mellitus may be caused by
o Endocrine disease such as Cushing’s syndrome or Acromegaly.
o Bacterial infection.
o Muscular dystrophy.
o Eating too much sugar.
(53) Oral glucose tolerance test(OGTT)
o A 75 GM glucose load is usually used.
o Can be very dangerous and must be avoided in the elderly.
o If fasting blood glucose is 100 mg/dl, OGGT is needed to
establish the diagnosis of diabetes.
o OGGT can differentiate between Type 1 and Type 2 diabetes.
(54) High plasma insulin levels has the following effects
o It stimulates breakdown of adipose tissue.
o It stimulates the storage of glycogen in the liver.
o It enhances protein catabolism.
o It increases the absorption of glucose from the intestine.
(55) Gestational diabetes
o Occurs when a pregnant eats too much.
o Occurs when a diabetic becomes pregnant.
o Occurs when a pregnant woman becomes diabetic.
o Occurs when the fetus becomes diabetic.
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10. (56) The most important function of insulin is …
o To release glucose from the liver.
o To maintain normal blood glucose level.
o To avoid late diabetic complications.
o To utilize fat.
(57) In Type 1 diabetes (IDDM)
o Insulin is unable to promote utilization of glucose.
o Pancreas does not produce insulin.
o The cells of the body lack insulin receptors.
o Blood glucose level may be normal.
(58) Persistent hyperglycemia may…
o Cause thirst, polyuria and tiredness.
o Be asymptomatic for many years.
o Cause enlargement of liver.
o Cause late complication such as sarcoidosis.
(59) Why glucosuria is a consequence of hyperglycemia
o Because the kidneys are damaged.
o Because the amount of blood filtered by the kidneys is incorrect.
o Because the amount of blood filtered by the kidneys is decreased.
o Because the kidneys are unable to reabsorb all the glucose in the filtered
blood.
(60) Glucocorticoids and mineralocorticoids are secreted by the:
o Pancreas.
o Adenohypophysis.
o Adrenal glands.
o Gonads.
(61) A female patient with Cushing's syndrome is expected to have
the following:
o "Buffalo hump" and hypertension.
o Dehydration and menorrhagia.
o Migraine headaches.
o Loss of weight.
(62) The most common cause of Cushing's syndrome is:
o Insufficient ACTH production.
o Hyperplasia of the adrenal cortex.
o Pituitary hypofunction.
o Deficient adrenocortical hormones.
(63) In Addison's disease, hypotension can be explained by a
disturbance in the production of :
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11. o Glucocorticoids.
o Androgens.
o Mineralocorticoids.
o Estrogens.
(64) In hypoglycemic reaction to insulin, emergency rapid
adjustments made by the body are associated with the increased
activity of:
o Pituitary gland.
o Thyroid gland.
o Adrenal gland
o Pancreas.
(65) Which of the following diseases is characterized by arrhythmias,
tremors, diarrhea and weight loss:
o Cushing's syndrome.
o Hypothyroidism.
o Addison's disease.
o Hyperthyroidism.
(66) Follicle stimulating hormone (FSH):
o Released from the posterior pituitary.
o Responsible for the release of adrenal medullary hormones.
o Released in response to TRH stimulation.
o Responsible for growth of ovarian follicle / spermatogenesis.
(67) Steroid hormones act by:
o Activatring adenyl cyclase.
o Binding to cellular membrane.
o Infleuncing RNA synthesis.
o Binding to plasma proteins.
(68) Hormones may have the basic molecular structure, which is :
o fatty acid.
o Steroid.
o Glucoside.
o Triglyceride.
(69) Acute infarction of the anterior pituitary gland may be followed by
features of :
o Cushing's disease.
o Acromegaly.
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12. o Panhypopituitrism.
o Diabetes insipidus.
Prepared by Dr Suhail S Kishawi
Head of medical Department Shifa Hospital
Consultant Diabetologist & Endocrinologist
18 March 2005
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